Abstract: Objective To explore the liver histological changes and HBsAg and HBcAg expression in patients with chronic hepatitis B and low serum alanine aminotransferase（ALT） levels （<2×upper limit of normal,ULN）. Methods Eighty patients with chronic hepatitis B virus infection received liver biopsies from July 2010 to November 2013 in this study. The liver histopathologic changes were analyzed and HBsAg and HBcAg expression in liver tissues were detected by immunostaining. Results The average age in 50 HBeAg-positive patients was （28.52±9.10） years,significantly younger than 30 HBeAg-negative patients [（39.37±10.14）years,P<0.01];The serum HBV DNA load in HBeAg-positive patients was （7.79±0.73） lg copies/ml,significantly higher than that in HBeAg-negative patients[（4.52±1.67） lg copies/ml,P<0.01];The liver inflammation grades and fibrosis staging in HBeAg-positive patients were（1.00±0.57） and （0.38±0.57）,significantly lower than those in HBeAg-negative patients [（1.27±0.45） and （1.07±1.11）,repectively,P<0.01];There were no significant differences in immunostaining scores （ISS） of HBsAg [（0.93±0.92）and （0.77±0.93）,P>0.05] or HBcAg [（1.58±0.88） and （1.63±0.92）,P>0.05] between the two groups;The liver histological inflammation grades and fibrosis staging in 22 patients over 40 years of age were （1.32±0.48） and （1.00±1.27）,respectively,significantly higher than those in 35 patients younger than 30 years of age [（0.69±0.58） and （0.40±0.50）,respectively,P<0.01];No significant differences were observed between both genders in either liver inflammation grades [（1.12±0.55） and（1.07±0.54）] or fibrosis staging [（0.71±0.82） and （0.50±0.96）];There were no significant differences in ISS of HBsAg [（0.89±0.89） and （0.82±1.00）] or HBcAg [（1.44±0.94） and （1.24±1.09）] between males and females. Conclusions Patients over 40 years of age with hepatitis B virus infection are recommended for liver biopsies in time in order to elucidate the histopathological changes.

Key words: Hepatitis B, Alanine aminotransferase, Clinical features, Liver, Pathology